Pulmonary tuberculosis mortality risks in a cohort of HIV/AIDS patients in Puerto Rico

Pulmonary tuberculosis (TB) has re-emerged in relation to the HIV epidemic. To gain knowledge of TB infection in HIV-infected patients, we studied 106 HIV-TB cases in a cohort of 2,646 patients in Puerto Rico between January 1992 and September 1999. The TB prevalence was 4%; 82% were males and 73.6% were injecting drug users (IDU). At the time of TB diagnosis, the mean CD4+ T-cell count was 174/mm3, 35% were in antiretroviral treatment and 42.5% had another AIDS related condition. Only 9% received two or more antiretroviral medications. The death rate in the first year after the TB diagnosis was 55%. A Cox proportional hazard analysis showed that CD4+ T-cells <200/mm3 (p<0.01), history of toxoplasmosis (p<0.01), wasting syndrome (p<0.01) and lack of antiretroviral treatment (p=0.12) increased their mortality risk. The studied patients had a highly compromised immune system at the time of TB diagnosis. Low CD4+ T-cells (essential to control the TB infection) significantly increased the hazard and mortality risk of the cases studied. Early antiretroviral therapy in combination is recommended in HIV-infected patients, particularly in those with IDU, TB history and low CD4+ T-cell levels, to ensure an optimal immune system function that limits the pulmonary TB morbidity and mortality.